Sürdürülebilir Kalkınma Amaçları

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• MakaleAçık Erişim2026/r/kostu/10865
  The role of mood in complex regional pain syndrome: Cause or consequence?

  Ahi, Emine Dundar; Kuculmez, Ozlem

  Aim: Complex Regional Pain Syndrome (CRPS) involves pain and dysfunction in multiple nervous system pathways. Psychological symptoms such as anxiety, depression, and difficulty coping often accompany the physical aspects of the condition. This study sought to examine whether mood-related factors play a causal role in the onset of CRPS or if individuals with pre-existing psychological conditions exhibit increased susceptibility to its development. Materials and Methods: This is a cross-sectional study that included 131 patients with a history of trauma or surgery who were referred for rehabilitation within the first three months following the incident. Among them, 70 patients were diagnosed with CRPS, while 61 patients formed the control group. Each participant underwent evaluation through the Short Form-36, Visual Analog Scale (VAS), Beck Depression Inventory, and the Beck Anxiety Inventory. Results: The study included 62 men and 69 women, with no significant differences in anxiety and depression scores observed between the CRPS group and the control group (p>0.05 for both). However, individuals with CRPS reported notably higher scores on the VAS (p<0.05). In addition, their scores were significantly lower in the Short Form-36 subdomains related to pain intensity (p<0.05), social functioning (p<0.05), and physical role limitations (p<0.05). Conclusion: The results indicate that an individual's baseline mood does not seem to contribute to the development of CRPS. These mood changes may be only the result of the disease, as pain level, social function, and physical role were determined to be worse in these patients.

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• MakaleYalnız künye2026Scopus SJRQ3/r/kostu/10665
  Prevalence of sarcopenia and its functional correlates in women with lower-extremity lipedema: A cross-sectional observational study

  Ozbek, Ilhan Celil; Kuculmez, Ozlem; Dundar Ahi, Emine

  Background: Lipedema is a chronic, progressive adipose tissue disorder affecting mainly women, characterized by bilateral, disproportionate fat accumulation in the lower extremities. The condition is often associated with pain, heaviness, and functional limitations. While the adipose tissue changes in lipedema are well-described, its impact on muscle mass, strength, and functional performance remains underexplored. This study aimed to evaluate the prevalence of sarcopenia and its relationship with lipedema severity. Materials and methods: A cross-sectional observational study was conducted on 48 women with clinically diagnosed lower-extremity lipedema. Diagnosis followed the International Lipoedema Association and German S2k guidelines. Sarcopenia was assessed using a multidimensional approach, including ultrasonographic rectus femoris thickness, handgrip strength, the Five Times Sit-to-Stand Test, and four-m walking speed. The lipedema stage was determined using morphological criteria. Statistical analyses evaluated the relationships between sarcopenia, functional parameters, and lipedema stage. Results: Participants had a mean age of 47.2 ± 8.4 years and a BMI of 33.0 ± 4.3 kg/m2. Sarcopenia was identified in 33.3% of participants, with 14.6% classified as severe. Those with sarcopenia exhibited lower rectus femoris thickness and slower walking speed (p < .05). Advancing lipedema stage correlated with reduced muscle thickness, weaker handgrip strength, slower gait, and prolonged Five Times Sit-to-Stand Test duration (p < .05). Stage 3 patients demonstrated the highest prevalence of sarcopenia, indicating progressive impairment in muscle mass and functional performance with disease severity (p < .05). No significant associations were found between age or BMI and muscle parameters (p > .05). Conclusions: Sarcopenia is prevalent in women with lower-extremity lipedema and increases with disease stage. Comprehensive musculoskeletal assessment should be integrated into lipedema management to address functional impairment and optimize patient care.

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  AtıfScopus2·WoS2

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• MakaleAçık Erişim2026Scopus SJRQ1/r/kostu/10484
  Attitudes and behaviors toward hypnosis and hypnotic susceptibility in physiotherapy patients: a cross-sectional study

  Kuculmez, Ozlem; Dundar Ahi, Emine; Ozbek, Ilhan Celil; Afsar, Sevgi Ikbali

  Background and objectives: Hypnosis is a focused cognitive state with increased suggestibility and neurophysiological changes, but misconceptions remain despite its clinical value. This study examined physiotherapy patients' beliefs and behaviors about hypnosis, their hypnotic suggestibility levels, and the relationships among these factors. Materials and methods: This cross-sectional study included voluntary adult participants aged 18–70 years who presented to the physical medicine and rehabilitation outpatient clinics. Individuals with psychiatric disorders, cognitive impairment, poor general health, illiteracy, or incomplete data were excluded. Demographic characteristics were recorded, and participants were asked to complete the attitudes and beliefs toward hypnosis scale (VSABTH-T) and the Short Form of the Suggestibility Scale (SSS). The study evaluated participants' attitudes, beliefs, and levels of suggestibility, as well as the relationships among these variables. A significance level of p < 0.05 was accepted for all statistical analyses. Results: The study analyzed data from 399 participants (65.9% male, 34.1% female) with a mean age of 42.68 ± 16.75 years. 75.4% of participants had limited knowledge, and 3.5% had hypnosis experience. Predominantly expressed concerns regarding hypnotic procedures were 86.2% fear, 61.9% emerging from hypnosis, 51.8% losing control, and 33.3% of the participants defined hypnosis as dangerous. Participants had a mean attitude and behavior score toward hypnosis of 107.21 ± 15.8 and a mean hypnotizability score of 53.29 ± 8.76. Although age, occupation, and income level showed very weak but statistically significant correlations with the total VSABTH-T scores (p = 0.001), there was no correlation with total SSS scores (p > 0.05). Attitudes toward hypnosis and hypnotic suggestibility are significantly affected by age, education, occupation, income, and particularly the level of knowledge about hypnosis (p < 0.05). Total VSABTH-T and SSS scores were not correlated (p = 0.069), although very weak associations were observed between subdimensions (p < 0.05). Conclusion: Physiotherapy patients demonstrated limited hypnosis knowledge and experience and misconceptions. Demographic factors showed weak associations with attitudes and suggestibility. Findings highlight that personal beliefs and demographics interact complexly in shaping hypnotic responsiveness, emphasizing the need for targeted education to reduce misconceptions.

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• MakaleYalnız künye2025Scopus SJRQ2/r/kostu/10371
  Referential hallucination and clinical reliability in large language models: a comparative analysis using regenerative medicine guidelines for chronic pain

  Kuculmez, Ozlem; Usen, Ahmet; Ahi, Emine Dündar

  This study compared language models’ responses to open-ended questions on regenerative therapy guidelines for chronic pain, assessing their accuracy, reliability, usefulness, readability, semantic similarity, and hallucination rates. This cross-sectional study used 16 open-ended questions based on the American Society of Pain and Neuroscience’s regenerative therapy guidelines for chronic pain. Questions were answered by ChatGPT-4o, Gemini 2.5 Flash, and Claude 4 Opus. Responses were rated on a 7-point Likert scale for usability and reliability, and a 5-point scale for accuracy. Hallucinogenicity, readability (FKRE, FKGL), and similarity (USE, ROUGE-L) were also assessed. Statistical comparisons were made, with significance set at p < 0.05. Claude Opus 4 showed the highest reliability (5.19 ± 1.11), usefulness (5.06 ± 1.0), and clinical accuracy (4.06 ± 0.68), outperforming ChatGPT-4o (4.13 ± 0.96; 3.94 ± 0.85; 3.38 ± 0.72) and Gemini 2.5 (4.19 ± 0.98; 4.06 ± 0.93; 3.38 ± 0.62). Claude had the lowest reference hallucinations (RHS 4.44 ± 3.18) vs. ChatGPT-4o (8.38 ± 1.86) and Gemini 2.5 (8.75 ± 1.73). In semantic similarity, Claude (0.68 ± 0.08) and Gemini (0.65 ± 0.07) surpassed ChatGPT-4o (0.60 ± 0.09). Gemini led in ROUGE-L F1 (0.12 ± 0.03) vs. Claude (0.10 ± 0.02) and ChatGPT-4o (0.07 ± 0.03). Readability was similar, though Gemini had a higher FKGL (11.3 ± 1.06) than Claude (10.3 ± 2.09). Claude Opus 4 showed superior accuracy, reliability, and usefulness, with significantly fewer hallucinations. Readability scores were similar across models. Further research is recommended.

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  AtıfScopus2·WoS3·OpenAlex3

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• MakaleAçık Erişim2025Scopus SJRQ1/r/kostu/10263
  Effects of qigong for physical and psychological well-being in pregnancy: A multicenter randomized controlled trial

  Dundar Ahi, Emine; Kuculmez, Ozlem; Ikbali Afsar, Sevgi; Eyup Dogan, Rahsan

  Background Psychological stress and anxiety during pregnancy can adversely affect both maternal and fetal health. Qigong, a traditional Chinese mind–body exercise, is believed to promote physical and mental well-being during pregnancy. This study aimed to investigate the effects of qigong on anxiety, stress, and exercise self-efficacy in pregnant women. Methods This multicenter randomized controlled clinical trial included pregnant women in their second trimester attending prenatal education classes at Baskent University and Alaaddin Keykubat University. Women in the first or third trimester with uncontrolled systemic diseases, high-risk pregnancies, or irregular attendance were excluded. Participants were randomly assigned via Randomizer.org to either the Qigong group or the control group. The Qigong group performed Baduanjin qigong exercises for 30–45 min, three times a week, while the control group received standard prenatal counseling. Demographic data were recorded. All participants completed the Pregnancy-Related Anxiety Scale (PrAS), Pregnancy Stress Rating Scale (PSRS), and Pregnancy Exercise Self-Efficacy Scale (P-ESES). Results A total of 102 pregnant women were analyzed (qigong group: 52; control group: 50). The mean age was 27.95 ± 3.66 years, and the mean gestational week was 26.94 ± 2.12. The qigong group showed significantly lower systolic and diastolic blood pressure increases compared to the control group (p &lt; 0.05). Exercise self-efficacy scores increased significantly in the qigong group (p &lt; 0.05). Pregnancy-related anxiety and stress scores, including all subscales, showed significant improvement in the qigong group (p &lt; 0.05), with no significant changes in the control group (p &gt; 0.05). Conclusions Baduanjin qigong was effective in reducing anxiety and stress levels and improving exercise self-efficacy in pregnant women. This non-pharmacological intervention may offer a safe, supportive approach to mental well-being during pregnancy.

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• MakaleAçık Erişim2024Scopus SJRQ1/r/kostu/10296
  High-frequency laser therapy: a new alternative to physiotherapy in the treatment of cervical disk hernia

  Kuculmez, Ozlem; Dündar Ahi, Emine; Cosar, Sacide Nur; Guzel, Sukran

  Introduction: High-frequency laser therapy has been increasingly used in several musculoskeletal disorders, but there is still a lack of evidence for the usage of the device in neck pain. This study aimed to compare the effectiveness of physiotherapy, high-frequency laser, and exercise therapy methods in the treatment of pain in cervical disk herniation. Methods: It was a multicenter, randomized, controlled clinical trial. Patients aged between 18 and 65 with neck pain and a diagnosis of cervical disk hernia were included in the study. Patients with a history of cervical surgery, rheumatism, cancer, or pacemaker were excluded from the study. The patients were randomized into 15 sessions of physiotherapy, high-frequency laser, or exercise therapy groups and evaluated with a range of motion, visual analog score, Neck Disability Index, and Short Form Health Survey-36 before treatment, after treatment, and in 1st and 3rd months. p < 0.05 was considered statistically significant. Results: In total, 150 patients were analyzed. There was a significant improvement in range of motion, visual analog score, Neck Disability Index, and Short Form Health Survey-36 scores in three groups after 3-month follow-up (p < 0.05). The improvement was statistically greater in the physiotherapy and high-frequency laser therapy groups (p < 0.05), but there was no significant difference between these two groups (p > 0.05). Discussion: The results in the physiotherapy and high-frequency laser therapy groups were better than the exercise group. They may be alternatives to each other in cervical disk hernia treatment.

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  AtıfScopus1·WoS1·OpenAlex2

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• MakaleYalnız künye2023Scopus SJRQ2/r/kostu/10743
  Comparison of the effectiveness of dry needling and high-intensity laser therapy in the treatment of myofascial pain syndrome: a randomized single-blind controlled study

  Ahi, Emine Dundar; Sirzai, Hulya

  Myofascial pain syndrome (MPS) is a very common disease in the population that seriously affects quality of life. Although many treatment modalities are used, there is still no common protocol. The aim of this study was to compare the effectiveness of high-intensity laser therapy (HILT) and dry needling options. This prospective study included 108 patients with neck and/or upper back pain, diagnosed with MPS, who were randomly separated into 3 groups: the exercise group, the exercise + HILT group (HILT group), and the exercise + dry needling group (needling group). The visual analog scale (VAS), neck disability index (NDI), short form-36 (SF-36) scores, and neck range of motion (ROM) values of the patients before and after treatment were recorded and compared between the groups. In all 3 groups, the VAS and NDI scores decreased and ROM levels increased after treatment. The results in the HILT and needling groups were statistically significantly better than those of the exercise group (p < 0.05).The addition of HILT and dry needling to exercises is seen as a more successful treatment option to reduce pain in MPS. Clinical trial registration number: NCT05078333.

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  AtıfScopus8·WoS8·OpenAlex12

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• MakaleAçık Erişim2023Scopus SJRQ3/r/kostu/10466
  Short-term Effectiveness of High-intensity Laser Therapy in De Quervain Tenosynovitis: A Prospective, Randomized, Controlled Study; [De Quervain Tenosinovitinde Yüksek Yoğunluklu Lazer Tedavisinin Kısa Dönem Etkinliği: Prospektif, Randomize, Kontrollü Bir Çalışma]

  Dundar Ahi, Emine; Sirzai, Hulya

  Objective: The effectiveness of high-intensity laser therapy (HILT) has been demonstrated in some musculoskeletal repetitive strain injury disorders. This study aimed to determine the short-term effectiveness of HILT in de Quervain tenosynovitis (DQT). Methods: Sixty-four patients with DQT diagnosis (32 males, 32 females; 18-65 years) were randomly divided into two groups. A short opponens splint was applied to both groups and HILT to the treatment group and sham HILT to the control group once a day, on alternate days, 3 days a week, for 5 weeks. Pre-and post-treatment evaluations were made using a visual analog scale (VAS); Quick Disabilities of the Arm, Shoulder, and Hand questionnaire; Short Form-36 Health Survey; and hand grip strength test. Results: The demographic results (age, gender, duration of complaint, body mass index, occupational group) of both groups were similar (p>0.05). The pre-treatment measured values were similar in both groups (p>0.05). After a 5-week treatment, a significant improvement was observed in all parameters in both groups. Post-treatment, hand grip strength levels were statistically higher in the HILT group than in the sham therapy group, and VAS levels were significantly lower (p<0.001). Conclusions: HILT is a non-invasive and reliable method that increases grip strength and decreases pain in DQT.

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  AtıfScopus9·WoS9·OpenAlex11·TR Dizin1

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• MakaleAçık Erişim2021/r/kostu/10968
  Frequency and Risk Factors of Lower Limb Disorders in Work-related Musculoskeletal Disorders

  Arikan, Hulya; Ahi, Emine Dundar

  Objective: Work-related musculoskeletal disorders(WMSDs) are a serious health and economic problem. Occupationalhealth and safety is important for preventing these disorders. There aremany reports about work-related upper limb musculoskeletal disorders,but few about the lower limb. Most of lower limb reports were basedon self-reported scales. Our aim was to determine the frequency andrisk factors of lower limb disorders in WMSDs in workers in heavy industry. Material and Methods: We included 110 male and femaleheavy industry workers among 1,268 patients diagnosed with a WMSDwho were admitted to the physical medicine and rehabilitation (PMR)outpatient clinic between 2018 and 2020, and were diagnosed with alower limb WMSD by physical and radiological examinations. We recorded demographic data, risk factors, and lower limb WMSD diagnoses for all patients. Results: The incidence of lower limb WMSDs(n=110) among all patients diagnosed with a WMSD in the PMR outpatient clinic was 8.67%. Of these lower extremity WMSDs, the mostcommon site was the knee (83.6% of patients), followed by the feet-ankles (24.5%), and the hip joint (20.9%). In our study, the frequency ofwearing special shoes/boots was statistically significantly higher incases with WMSDs in the feet-ankles (p<0.001). Conclusion: WMSDsare seen in both the lower and upper extremities. Special shoes andboots designed for the working environment should include featuresthat would help to reduce WMSDs of the feet-ankles.

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• MakaleYalnız künye2021Scopus SJRQ3/r/kostu/10731
  Incidence of Neuropathic Pain in Patients with Thoracic Disc Pathologies Presenting with Chronic Upper Back Pain and Correlation of Herniation Grade with Pain Severity

  Ahi, Emine Dundar; Goktan, Asli

  AIM: To determine the incidence of neuropathic pain (NP) in patients with thoracic disc herniation (TDH) and to determine whether there is any correlation between pain severity and herniation grade. MATERIAL and METHODS: A total of 110 patients diagnosed with TDH with chronic non-specific thoracic spine pain were included in our cross-sectional observational study. Data including magnetic resonance imaging findings, bulging, protrusion, extrusion and sequestration were retrospectively analysed. We determined the incidence of NP in patients by administering the self report form Douleur Neuropathique 4 (DN4) questionnaire. Pain severity was assessed using Numeric Rating Scale scores. RESULTS: In our study, 79.1% of TDHs were located below the T7-8 level. The patients were divided into two subgroups on the basis of the results of the DN4 questionnaire: NP subgroup, 43 (39.1%), and non-NP subgroup, 67 (60.9%). Although there was no statistically significant association between presence of NP and herniation grade bulging, protrusion or sequestration (p>0.05), the rate of herniation in the extrusion grade was statistically significantly higher in patients with NP than in those without NP (p=0.004). The pain severity of the patients with herniation grade extrusion was statistically higher than that of patients with other non-extrusion grades (p=0.035). CONCLUSION: TDH should be considered in patients with neuropathic chronic back, chest and abdominal pain. If the patient's pain characteristics indicate NP, a diagnosis of TDH becomes more likely, considering that nearly 4 out of 10 patients with TDH have NP.

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  AtıfScopus4·WoS3·OpenAlex4

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